Division ofPublic Health

College of Human Medicine

Division ofPublic Health

College of Human Medicine

Mieka Smart, DrPH

Assistant Professor

Leading the Flint Area Study.

Within the Flint Center for Health Equity Solutions, I am leading the Flint Area Study, which seeks to recruit approximately 400 Flint families for a study of inter- and multi-generational transmission of risk and resilience. This project will establish a resource of comprehensive longitudinal epigenetic data, including environmental exposures, with a diverse cohort. Longitudinal cohort studies like the Framingham Study have provided the framework needed to make strides in the collective understanding of interactions among genetics, environment, behavior and public health interventions. However, for comprehensive understanding of these interactions and their subsequent long-term consequences, diverse longitudinal cohorts are required. We will establish a diverse cohort of randomly selected occupied residential dwellings, oversampling in areas affected most by factors contributing to marginalization. We will conduct household interviews with occupants of selected dwellings, acquiring social-behavioral measures, physical measures, and biological specimens.

Monitoring the impact of policy-based environmental interventions.

Recent investments and marketing campaigns in the sub-Saharan Africa region signal that residents of countries in that region are a targeted and developing demographic for the alcohol industry. Some African governments have responded by initiating public health policy measures designed to thwart the effectiveness of alcohol industry marketing campaigns. One such public health measure is the pending ban on satchet alcohol sales in Uganda. Satchet alcohol (soft plastic pouch-style baggies containing double-, triple-, or quadruple servings of alcohol for consumer purchase) is currently legally sold in Uganda. I am currently working with faculty in the Makerere University School of Public Health to establish a sample of approximately 100 alcohol sales locations that will be observed and monitored longitudinally before and after the sales ban goes into effect.

I recently completed a secondary data analysis of how alcohol-related disciplinary actions on college campuses changed among Maryland college students after the 2011 Maryland state alcohol tax increase from 6% to 9%. My study illustrated that the impact of state-level alcohol tax policy interventions can be measured and detected for young adults in college, which fills a gap in the current alcohol tax intervention literature. The interrupted time series analysis showed a significant decrease in count of alcohol-related disciplinary actions after the tax and indicated that students’ disposable income likely significantly mediates the effect of the tax on disciplinary actions at more pricy colleges.

High cortisol response to stress is associated with substance abuse disorder (SUD) in young adults. Beyond my own interest in mental health and substance abuse treatment monitoring, there are many immediately applicable areas for public health impact from a more cost-accessible test of stress response, including palliative care and sports medicine. In addition, there is incredible potential for the utility of this technology in developing countries. In my pilot project I obtained de-identified saliva specimens from colleagues at the San Luis Potosi Bio-bank in Mexico. We established the amount of cortisol in each sample with a standard ELISA assay test, took a cortisol measurement with LIAM™, and then compared the ELISA results to the LIAM™ results. Our findings established that LIAM and ELISA are correlated even when the LIAM is used in a real world context (at a field-based data collection site in a developing country). Literature indicates that high cortisol response to stress is associated with problem drinking in young adults. I want to use novel technology to explore whether levels of cortisol change after intervention for SUDs and assess whether cortisol response changes. If there is change, is it moderated by the presence of comorbid stress-related chronic mental disorder? The knowledge gained from this research will hopefully provide insight into the mechanisms of treatment for SUDs.